本研究旨在探討台灣於全民健康保險制度下，青光眼治療的醫療資源耗用情形。本研究屬回溯性研究，係以西元2004年1月至2005年12月底，台灣南部某醫學中心和某區域醫院為範圍，蒐集眼科門診之青光眼小樑切除手術(醫學中心45人次，區域醫院9人次，共54人次)，及閉鎖性青光眼虹膜雷射手術後患者(醫學中心248人次，區域醫院66人次，共314人次)，統計其手術後一年間眼科醫療資源耗用情形，並依各類病患特質，疾病特性及醫院別為變項，分析其對青光眼醫療資源耗用的差異性及影響性。研究結果如下：
1. 青光眼小樑切除手術：影響初次門診總費用的因素經逐步迴歸分析後為疾病特性之次診斷差異(包括玻璃體出血及白內障)，手術碼數及內科合併症(糖尿病，腎衰竭)，其R2=0.763。在初次門診總費用及其一年內總醫療費用之差異性分析中，可見在院區別及疾病特性(包括診斷碼數，手術碼數及青光眼種類)有顯著差異。
2. 青光眼虹膜雷射手術：影響一年內總醫療費用的因素經逐步迴歸分析後為疾病特性中的診斷碼數及病患的性別，其R2=0.215。差異性分析顯示：在初次門診總費用以區域醫院較高；一年內總醫療費用則以病患特質(女性較高)及疾病特性(診斷碼數)有顯著差異。
結論：
青光眼虹膜雷射及小樑切除手術的醫療資源耗用，在病患特質及疾病特性有相當的影響；另外，病患特質，疾病特性及醫院別的各變項在醫療資源耗用上也多有差異。而一年內總醫療費牽涉的變數太多，以至於個別變異太大，讓本研究許多變項未如預期般顯著呈現其差異性及影響性。

This study is to understand the medical resources utilization of glaucoma treatment under national health insurance (NHI) in Taiwan. The study is retrospective collection the one-year ophthalmic medical resources utilization of the patients after receiving glaucoma surgery (trabeculotomy), or laser (laser iridotomy) between Jan.1, 2004 and Dec.31, 2006 in a medical center and a regional hospital in southern of Taiwan. There are 54 patients in trabeculotomy group, including 45 patients in the medical center and 9 patients in the regional hospital. There are 314 patients in laser iridotomy group, including 248 patients in the medical center and 66 patients in the regional hospital. The results of the different and influential factors (including personal characteristics, diseases characteristics, and different hospitals) in glaucoma medical resources utilization were presented below:
1. Trabeculectomy group: The influential factors in initial clinic fee are diseases characteristics including the difference of the the secondary diagnosis (vitreous hemorrhage and cataract), the numbers of operation, and the medical co-morbidity (diabetic mellitus, and chronic renal failure). The R2 is 0.763. The initial and one-year total clinical fees are different in different hospital, and diseases characteristics incluning diagnosis numbers, operation numbers, and types of glaucoma.
2. Laser iridotomy group: The significant influential factors in one-year total clinic fees are diagnosis numbers in disease characteristics and gender in personal characteristics. The R2 is 0.215. The different analysis showed: The initial clinic fee is higher in regional hospital. The one-year total clinic fees are significant different in personal characteristics (female is higher) and diseases characteristics (diagnosis numbers).
Conclusion:
The personal characteristics and diseases characteristics are significant influential factors in medical resources utilization in glaucoma trabeculectomy and laser iridotomy. The subtypes of personal characteristics, diseases characteristics, and hospital difference also showed significant differences in glaucoma resources utilization. The factors affecting one-year total clinic fees may be more various and complex beyond our investigation. So the result was not as promising as we expected.

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